New Delhi: There’s much in common among AIIMS director Randeep Guleria, cardiologist Balram Bhargava, who heads the Indian Council of Medical Research (ICMR), V.K. Paul of the government thinktank Niti Aayog, WHO chief scientist Soumya Swaminathan, and Public Health Foundation of India (PHFI) president Dr Srinath Reddy, who is also on the steering committee of the WHO-led Solidarity trial to look for an effective Covid-19 treatment.
These luminaries of the medical field are all playing an important role in handling the biggest health crisis the world has faced in decades, Covid-19. But that’s not it. All of them have either taught or studied at AIIMS Delhi, the premier medical facility from the early years of Independent India that continues to top the government’s medical college rankings year after year, including in 2020.
Everyone in India — from the low-income patients who throng the hospital’s OPD for its promise of affordable care, to VIPs who cut through lines for treatment — knows AIIMS is the best in the country.
But its reputation doesn’t necessarily come from the functions it performs as a hospital, doctors and students say. It comes from AIIMS’ ability to produce award-winning physicians year after year.
But what exactly is it that makes AIIMS the best medical institution in a country that has over 540 medical colleges and is known for “exporting” doctors to countries around the world?
A ‘temple’ of modern medicine
Dr P.K. Julka, an oncologist who retired from the institute as dean in 2016, says everything “is top of the line” at AIIMS. “From equipment to medical protocols, and, most importantly, the freedom to pursue your research interests,” he added.
Like so many of the institute’s alumni, Julka has had an illustrious career: He was the first to conduct a peripheral blood stem cell transplant in the country (1995), and was awarded the Padmi Shri for his contributions to medicine in 2013. “AIIMS made this possible,” he added.
The foundation stone of AIIMS Delhi was laid in 1952, and it came into being as an autonomous institution through the AIIMS Act, 1956.
It was crafted in line with the vision of India’s first prime minister, Jawaharlal Nehru, and first Health Minister Rajkumari Amrit Kaur, in whose honour the hospital’s OPD is named.
AIIMS was among Nehru’s “temples” of modern India, set up to serve as a centre for excellence in the medical sciences. From the time of its christening, it was decided that it would be the best, and everyone associated with it treated it as such.
“Rajkumari fashioned it like a gurukul: Students and teachers would stay together within this same learning space. It was her pet project,” said Dr Chandrakant Pandav, professor of community medicine who joined AIIMS in 1971 as an undergraduate. “Bright Indians who had gone abroad to study medicine were called back to serve their country.”
AIIMS was primarily a research and teaching centre in the first few years of being set up, but began rapidly expanding in the mid-to-late 1980s.
“Managing patients has always been a problem. Earlier, we had fewer patients but were short on faculty. Now the number of patients who come is barely manageable despite having hundreds of doctors,” said Julka. “It has made prioritising time, between patient care, teaching, and research, more difficult.”
In 2003, the Government of India resolved to “correct” the imbalances of tertiary care availability and allowed the formation of six “AIIMS-like” institutions, a decision cemented by an ordinance in 2012 and subsequently an amendment legislation.
Since then, the number of “AIIMS-like” institutions has grown to 15. Another eight are in development. However, while they carry the brand, they don’t quite evoke the same respect, say doctors.
“The institutes are not comparable, they have miles to go before they reach where AIIMS Delhi is. That’s because they don’t have the same work culture that is already there in Delhi. The work culture is like a wave in the ocean, and they don’t have it,” Julka added.
For incoming students, the opportunity to study at AIIMS is both intimidating and exciting. “You’re prepared for that pressure,” said Mehek Arora, a second-year MBBS student at AIIMS, referring to the performance pressure. “Once you begin classes, you fall into the rhythm of things and get used to it.”
The 115-acre campus in Delhi houses 43 departments and has over 1,700 students — both undergraduate and postgraduate. Students say that juniors and seniors interact freely, without the fear of ragging that has become a big worry at India’s medical colleges. While the average student-teacher ratio is 29:1 in India (2018-19), it was estimated to be 6:1 at AIIMS in 2016. The goal of bettering academic performance is common, and so the environment is studious and buoyant, insiders say.
“At AIIMS, you’re exposed to patients at an early stage, newly developed medical protocols, emerging research. When something new comes out of the US, we hear about it within a week. There’s no spoon-feeding, but there’s a lot of space to learn and grow,” said Giridara Gopal, a PhD scholar in the field of community medicine.
Gopal did his MBBS from a medical college at Thanjavur in Tamil Nadu, before coming to AIIMS in 2012 for his MD. “Studying is not a burden here. It’s what keeps the community buzzing.”
According to old-timer Pandav, it is the sanctity of the student-teacher relationship that lies at the crux of AIIMS’ functioning. The focus, when he first arrived, was on “teaching and the freedom to teach”, he said.
“The roots of AIIMS lie in its emphasis on teaching and research. Students and teachers used to be like family, because it was the best students, and the best teachers, coming together to serve the public,” Pandav added.
The prestige of an AIIMS admission, combined with the fact that students and teachers have the best medical equipment and a free hand to conduct research, has kept the learning process novel.
“In peripheral colleges, you really don’t get access to the same information or leading protocols. Everything comes much later, whereas in AIIMS it’s all happening in real time,” said Gopal.
But AIIMS’ exclusivity also lends it a clique-like aura where outsiders may not be immediately accepted, some people say.
Dr Shobha Broor, a retired virologist who taught at the institute for 27 years, says “being accepted as an outsider” takes time.
“It took some time for them to accept me. I joined as an additional professor from PGIMS in Chandigarh. Initially, this was difficult to deal with, but I worked hard, and earned my place. The quality of students is what really makes the institute,” she said.
A rising number of patients isn’t the only problem AIIMS has faced over the years. It has also been marred with allegations of caste bias.
In 2007, after a massive protest over allegations that Dalit students were being failed in their examinations, AIIMS became the first higher education institution in India where systemic caste discrimination and abuse was investigated, resulting in the Thorat Committee Report.
The report found that 72 per cent of SC students felt discriminated against during teaching lessons. While reforms have ensured there is no longer outright discrimination, professors told ThePrint in 2019 that subtle caste biases still exist.
Even though AIIMS produces an average of 700 research papers a year, its global ranking in the area remains relatively low: According to the QS World University Rankings for Life Sciences and Medicine, AIIMS is ranked 231. For comparison, Harvard University stands at number one.
“With the sheer number of patients, the same interest in research and teaching is slowly disappearing,” said Pandav. “Clinical practice is taking precedence. Why do you think we haven’t won any Nobel prizes yet?”
The institute is currently hosting a series of video sessions, called the Grand Round, sharing its experiences of tackling Covid-19 with hospitals across the world. It is hosting a vaccine trial, and holding telemedicine sessions with doctors from other institutes who need guidance. The path ahead is uncertain, but Pandav puts it well, “The future of AIIMS lies in its past.”
This is an updated version of the report
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